COMSAE 114 / LATEST COMSAE 114 EXAM 2026/2027 PRACTICE QUESTIONS AND
STUDY GUIDE ALL COMPLETE ACCURATE EXAM APPROVED QUESTIONS AND
CORRECT DETAILED SOLUTIONS WITH RATIONALES (100% CORRECT VERIFIED
ANSWERS) NEWEST UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+
(BRAND NEW!) FULL REVISED COMSAE 114 EXAM
1. A 45-year-old male with hypertension presents with muscle weakness and fatigue.
Labs show Na+ 142 me/L, K+ 2.8 me/L, glucose 98 mg/ld., and renin activity low. Which
medication is most likely responsible?
A) Lisinopril
B) Losartan
C) Hydrochlorothiazide
D) Hydrochlorothiazide → CORRECT ANSWER (hydrochlorothiazide causes
hypokalemia with low renin due to volume contraction; Lisinopril/losartan increase
renin)
Rationale: Thiazide diuretics cause hypokalemia and suppress renin via mild volume
depletion; Ace/ARBs raise renin.
2. A 30-year-old woman presents with episodic severe headaches, palpitations, and
diaphoresis. BP 180/110 mmHg. Which lab finding confirms the diagnosis?
A) Elevated urinary VMA
B) Low plasma aldosterone
C) High TSH
D) Elevated urinary VMA → CORRECT ANSWER (pheochromocytoma confirmed by
elevated metanephrines or VMA)
Rationale: Pheochromocytoma causes episodic hypertension, headache, palpitations,
sweating; urinary VMA or plasma metanephrines are diagnostic.
3. A 67-year-old man with COPD presents with acute-onset right leg pain, pallor, and
coolness. No trauma. Femoral pulse palpable but popliteal and pedal pulses absent.
,Next best step?
A) CT angiogram
B) Emergent surgical thrombectomy → CORRECT ANSWER (acute limb ischemia
requires immediate revascularization)
C) Heparin drip alone
D) Doppler ultrasound
Rationale: Acute limb ischemia (pain, pallor, uselessness) is a surgical emergency;
immediate thrombectomy or embolectomy is indicated.
4. A 22-year-old male with no past medical history presents with sudden-onset sharp
chest pain and shortness of breath after a long flight. He is tachycardia and hypoxic.
What is the most specific diagnostic test?
A) D-dimer
B) CT pulmonary angiography → CORRECT ANSWER (gold standard for PE)
C) V/Q scan
D) ECG
Rationale: CTPA is definitive for pulmonary embolism in hemodynamically stable
patients; D-dimer is sensitive but not specific.
5. A 55-year-old female with breast cancer develops confusion, polyuria, and
constipation. Labs: Ca 13.2 mg/ld., Prep elevated. First-line treatment?
A) Pamidronate
B) IV fluids and calcitonin → CORRECT ANSWER (immediate lowering of severe
hypercalcemia)
C) Furosemide
D) Denosumab
Rationale: Severe hypercalcemia (Ca >13) requires IV hydration and calcitonin for rapid
reduction; bisphosphonates take days.
6. A 28-year-old G2P1 at 34 weeks’ gestation presents with right upper quadrant pain,
nausea, and platelets 80,000/mm³. AST 120 U/L, ALT 110 U/L. BP 145/95 mmHg. Most
likely diagnosis?
,A) Acute fatty liver of pregnancy
B) HELLP syndrome
C) HELLP syndrome → CORRECT ANSWER (thrombocytopenia, elevated LFTs,
hypertension)
D) Cholecystitis
Rationale: HELLP syndrome = Hemolysis, Elevated Liver enzymes, Low Platelets; often
with preeclampsia.
7. A 72-year-old man with Parkinson's disease presents with progressive difficulty rising
from a chair and a slow, shuffling gait. Exam shows rigidity and bradykinesia. Which
finding suggests atypical parkinsonism?
A) Resting tremor
B) Early falls and poor response to levodopa → CORRECT ANSWER
C) Asymmetric onset
D) Cogwheel rigidity
Rationale: Atypical parkinsonism (e.g., PSP, MSA) often presents with early falls,
symmetric symptoms, and poor levodopa response.
8. A 19-year-old college student reports recurrent episodes of palpitations, sweating,
and a feeling of impending doom that peak within 10 minutes. Between episodes, she is
completely asymptomatic. What is the first-line pharmacotherapy?
A) Fluoxetine
B) Sertraline → CORRECT ANSWER (panic disorder; SSRIs first-line)
C) Alprazolam
D) Propranolol
Rationale: SSRIs (sertraline, fluoxetine) are first-line for panic disorder; benzodiazepines
are second-line due to dependence risk.
9. A 60-year-old man with diabetes presents with painless gross hematuria. He has a 40-
pack-year smoking history. What is the most appropriate initial imaging study?
A) Renal ultrasound
B) CT urography → CORRECT ANSWER
, C) KUB
D) Cystoscopy
Rationale: CT urography is best for evaluating the entire urinary tract for transitional cell
carcinoma in a smoker with painless hematuria.
10. A 45-year-old female with fatigue, arthralgia’s, and a malar rash. ANA positive, anti-
dsDNA positive. Which renal finding is most specific for lupus nephritis class IV?
A) Minimal mesangial proliferation
B) Focal segmental glomerulosclerosis
C) Diffuse proliferative glomerulonephritis → CORRECT ANSWER
D) Membranous thickening
Rationale: Class IV lupus nephritis = diffuse proliferative GN with >50% glomeruli
involved; most severe and specific.
11. A 32-year-old male with HIV (CD4 50) presents with headache, fever, and confusion.
MRI shows ring-enhancing lesions. Most likely pathogen?
A) Cryptococcus neoformans
B) Toxoplasma gundi → CORRECT ANSWER
C) CMV
D) JC virus
Rationale: Ring-enhancing lesions in HIV with CD4 <100 are Toxoplasma until proven
otherwise; Cryptococcus typically shows basal meningitis.
12. A 25-year-old woman presents with acute-onset dyspnea and pleuritic chest pain
after starting oral contraceptives 3 weeks ago. Spiral CT shows bilateral segmental filling
defects. Which inherited thrombophilia is most likely?
A) Ant thrombin III deficiency
B) Factor V Leiden → CORRECT ANSWER
C) Protein C deficiency
D) Prothrombin G20210A
Rationale: Factor V Leiden is most common inherited thrombophilia in Caucasians; OCPs
increase VTE risk synergistically.
STUDY GUIDE ALL COMPLETE ACCURATE EXAM APPROVED QUESTIONS AND
CORRECT DETAILED SOLUTIONS WITH RATIONALES (100% CORRECT VERIFIED
ANSWERS) NEWEST UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+
(BRAND NEW!) FULL REVISED COMSAE 114 EXAM
1. A 45-year-old male with hypertension presents with muscle weakness and fatigue.
Labs show Na+ 142 me/L, K+ 2.8 me/L, glucose 98 mg/ld., and renin activity low. Which
medication is most likely responsible?
A) Lisinopril
B) Losartan
C) Hydrochlorothiazide
D) Hydrochlorothiazide → CORRECT ANSWER (hydrochlorothiazide causes
hypokalemia with low renin due to volume contraction; Lisinopril/losartan increase
renin)
Rationale: Thiazide diuretics cause hypokalemia and suppress renin via mild volume
depletion; Ace/ARBs raise renin.
2. A 30-year-old woman presents with episodic severe headaches, palpitations, and
diaphoresis. BP 180/110 mmHg. Which lab finding confirms the diagnosis?
A) Elevated urinary VMA
B) Low plasma aldosterone
C) High TSH
D) Elevated urinary VMA → CORRECT ANSWER (pheochromocytoma confirmed by
elevated metanephrines or VMA)
Rationale: Pheochromocytoma causes episodic hypertension, headache, palpitations,
sweating; urinary VMA or plasma metanephrines are diagnostic.
3. A 67-year-old man with COPD presents with acute-onset right leg pain, pallor, and
coolness. No trauma. Femoral pulse palpable but popliteal and pedal pulses absent.
,Next best step?
A) CT angiogram
B) Emergent surgical thrombectomy → CORRECT ANSWER (acute limb ischemia
requires immediate revascularization)
C) Heparin drip alone
D) Doppler ultrasound
Rationale: Acute limb ischemia (pain, pallor, uselessness) is a surgical emergency;
immediate thrombectomy or embolectomy is indicated.
4. A 22-year-old male with no past medical history presents with sudden-onset sharp
chest pain and shortness of breath after a long flight. He is tachycardia and hypoxic.
What is the most specific diagnostic test?
A) D-dimer
B) CT pulmonary angiography → CORRECT ANSWER (gold standard for PE)
C) V/Q scan
D) ECG
Rationale: CTPA is definitive for pulmonary embolism in hemodynamically stable
patients; D-dimer is sensitive but not specific.
5. A 55-year-old female with breast cancer develops confusion, polyuria, and
constipation. Labs: Ca 13.2 mg/ld., Prep elevated. First-line treatment?
A) Pamidronate
B) IV fluids and calcitonin → CORRECT ANSWER (immediate lowering of severe
hypercalcemia)
C) Furosemide
D) Denosumab
Rationale: Severe hypercalcemia (Ca >13) requires IV hydration and calcitonin for rapid
reduction; bisphosphonates take days.
6. A 28-year-old G2P1 at 34 weeks’ gestation presents with right upper quadrant pain,
nausea, and platelets 80,000/mm³. AST 120 U/L, ALT 110 U/L. BP 145/95 mmHg. Most
likely diagnosis?
,A) Acute fatty liver of pregnancy
B) HELLP syndrome
C) HELLP syndrome → CORRECT ANSWER (thrombocytopenia, elevated LFTs,
hypertension)
D) Cholecystitis
Rationale: HELLP syndrome = Hemolysis, Elevated Liver enzymes, Low Platelets; often
with preeclampsia.
7. A 72-year-old man with Parkinson's disease presents with progressive difficulty rising
from a chair and a slow, shuffling gait. Exam shows rigidity and bradykinesia. Which
finding suggests atypical parkinsonism?
A) Resting tremor
B) Early falls and poor response to levodopa → CORRECT ANSWER
C) Asymmetric onset
D) Cogwheel rigidity
Rationale: Atypical parkinsonism (e.g., PSP, MSA) often presents with early falls,
symmetric symptoms, and poor levodopa response.
8. A 19-year-old college student reports recurrent episodes of palpitations, sweating,
and a feeling of impending doom that peak within 10 minutes. Between episodes, she is
completely asymptomatic. What is the first-line pharmacotherapy?
A) Fluoxetine
B) Sertraline → CORRECT ANSWER (panic disorder; SSRIs first-line)
C) Alprazolam
D) Propranolol
Rationale: SSRIs (sertraline, fluoxetine) are first-line for panic disorder; benzodiazepines
are second-line due to dependence risk.
9. A 60-year-old man with diabetes presents with painless gross hematuria. He has a 40-
pack-year smoking history. What is the most appropriate initial imaging study?
A) Renal ultrasound
B) CT urography → CORRECT ANSWER
, C) KUB
D) Cystoscopy
Rationale: CT urography is best for evaluating the entire urinary tract for transitional cell
carcinoma in a smoker with painless hematuria.
10. A 45-year-old female with fatigue, arthralgia’s, and a malar rash. ANA positive, anti-
dsDNA positive. Which renal finding is most specific for lupus nephritis class IV?
A) Minimal mesangial proliferation
B) Focal segmental glomerulosclerosis
C) Diffuse proliferative glomerulonephritis → CORRECT ANSWER
D) Membranous thickening
Rationale: Class IV lupus nephritis = diffuse proliferative GN with >50% glomeruli
involved; most severe and specific.
11. A 32-year-old male with HIV (CD4 50) presents with headache, fever, and confusion.
MRI shows ring-enhancing lesions. Most likely pathogen?
A) Cryptococcus neoformans
B) Toxoplasma gundi → CORRECT ANSWER
C) CMV
D) JC virus
Rationale: Ring-enhancing lesions in HIV with CD4 <100 are Toxoplasma until proven
otherwise; Cryptococcus typically shows basal meningitis.
12. A 25-year-old woman presents with acute-onset dyspnea and pleuritic chest pain
after starting oral contraceptives 3 weeks ago. Spiral CT shows bilateral segmental filling
defects. Which inherited thrombophilia is most likely?
A) Ant thrombin III deficiency
B) Factor V Leiden → CORRECT ANSWER
C) Protein C deficiency
D) Prothrombin G20210A
Rationale: Factor V Leiden is most common inherited thrombophilia in Caucasians; OCPs
increase VTE risk synergistically.
